Total Expenditures (All Funds)

Cost of Property and Equipment

New Applications Received

Renewals Received

Investigations Opened

Investigations Closed

Disciplinary Actions Issued

Total Receipts Collected

Deficiencies were noted in the enforcement process including untimely activity in the investigation and prosecution functions.

In testing the enforcement process, we found:

We recommended the Department establish adequate procedures over investigative and prosecutorial duties.

Department officials concurred with our recommendation stating that a task force has been created to review past policies and procedures and to prepare policies and procedures that will meet the needs of the Department and address the concerns raised. Issuance and implementation of new guidelines is scheduled for July 1, 2000. (For previous Department responses, see Digest footnote #1.)

The Division of Enforcement’s procedures do not ensure that statute of limitations (SOL) dates are accurately entered into the Regulatory Administration and Enforcement System (RAES).

Two professions regulated by the Department (veterinarian and dental) have established statute of limitations periods. These periods are generally set at 3 to 5 years from the date of incident, or 3 years from receipt of a charge that a violation has occurred.

We reviewed the RAES activity for 25 cases that could require a statute of limitations date. In 9 of the 25 cases, a SOL date was not required. In 11 of the remaining 16 cases, a SOL date was not entered into the RAES; 1 SOL date was entered incorrectly; and 4 were entered correctly. (Finding 4, page 21) This finding has been repeated since 1995.

We recommended the Department implement procedures to ensure statute of limitations dates are accurately determined and entered into the Regulatory Administration and Enforcement System.

Department officials concurred with the recommendation, and said the 12 cases referenced have been corrected to reflect the proper SOL dates. Further, Enforcement has reviewed the procedures for entering SOL dates and has instructed investigators, supervisors and attorneys of the procedures to follow to ensure prompt completion of investigative and prosecutorial functions. (For the previous Department response, see Digest footnote #2.)

The Division of Enforcement has not maintained adequate documentation for case activity. Each time a case is worked on, the activity is to be documented on the Regulatory Administration and Enforcement System (RAES).

During audit testing of 60 cases, we noted 24 separate instances in which the RAES was not properly used. In 6 of the 24 instances, activity was not recorded on the RAES. In 9 of the 24 instances, activity was recorded on the RAES, but there was no documentation of any activity in the official investigation file. In 9 of the files reviewed, the status of the case was incorrectly reported on RAES. (Finding 5, page 22) This finding has been repeated since 1991.

We recommended the Department establish and enforce procedures for appropriate use of the RAES System and ensure appropriate documentation is maintained in the central investigation file.

Department officials concurred with our recommendation, stating the Enforcement and EDP personnel are formulating a new programming method, which, in conjunction with the guidelines task force, should address this issue. (For the previous Department responses, see Digest footnote #3.)

The Department and the Medical Disciplinary Board failed to develop criteria to determine when medical records are needed and failed to ensure that medical records are obtained when necessary. This finding is repeated from a program audit conducted by our Office in May 1997.

When a professional liability insurer settles a claim of alleged negligence against a physician, a report is required to be made to DPR’s Medical Disciplinary Board (225 ILCS 60/23(A)(3)).

We tested all mandatory reports received by the Department in FY 99 in which the total settlement paid by all parties was $500,000 or greater. For these 96 mandatory reports, insurers paid $55,622,872 for physicians who were the subjects of the mandatory reports.

We found 53 of 96 (55%) of the mandatory reports tested to be inadequate. In 52 of the 53, the Medical Disciplinary Board closed the case based on the involved physician’s response and the Medical Coordinator’s recommendation based on that response. The Department did not review any collaborative evidence such as medical records.

Twenty-two of the 53 reports we considered inadequate involved the death of a patient. All 22 were closed by the Medical Disciplinary Board without obtaining medical records.

When allegations involve the appropriateness of medical treatment, we question how adequate evidence can be accumulated and reasoned decisions made without receiving the medical records relating to the mandatory report. (Finding 6, pages 23-26)

We recommended the Department of Professional Regulation and Medical Disciplinary Board develop and implement criteria to determine when medical records are needed and ensure that medical records are obtained when necessary.

Department officials disagree with this finding. They stated that pursuant to the Medical Practice Act, the determination whether medical records should be obtained rests with the Coordinator and the Medical Disciplinary Board. Further, the statutorily designated medical experts can often determine reliably that there is not a Medical Practice Act violation even assuming that the records would confirm substandard physician conduct.

In response, the auditors stated that they have not concluded that simply because there was a monetary settlement that a violation of the Act has occurred. What they did conclude, as was concluded in the 1997 management audit of the Department, was the Department had not established criteria or guidelines as to when medical records should be obtained in mandatory report cases. Given that many mandatory reports involve questions concerning the appropriateness of medical treatment, we question how adequate evidence can be accumulated and reasoned decisions can be made without obtaining medical records, under any standard of evidence.

The Department failed to establish management controls over the activities of the Enforcement Division, including written policies and procedures over investigative, prosecutory, and probation/compliance activities. Consequently, some enforcement activities were not properly documented or reviewed, monitoring of disciplined physicians was inadequate, employees may not have received proper training, and potential conflicts of interest disclosures, if any, were not documented.

This finding is repeated from our 1997 Program Audit: "Physicians Regulated Under the Medical Practice Act."

The Department did not require prosecutors to maintain uniform documentation of how cases progressed and were resolved. Consequently, the contents of Prosecution Unit files varied and lacked consistent documentation of hearings, conferences, disciplinary orders, and other information used in resolving the case. Further, we found no evidence that the prosecution files are reviewed by supervisory personnel. Further, there are no written standards governing the timeliness of prosecution activities.

The Department did not properly monitor physicians who had been disciplined by the Department. Investigators assigned to monitor these cases did not assure that physicians whose licenses were revoked or suspended for a long term were no longer practicing, nor did they ensure that all physicians placed on probation were complying with the terms of their probations.

Although guidelines were developed that addressed the concerns of the 1997 program audit, these guidelines were never fully implemented. Consequently, the Department lacks guidelines over medical investigative activities, including how a medical investigation should be conducted, what documentation should be included in the case file, how quickly the investigation should be completed, how often supervisors should review cases, and what those reviews should include.

The draft training policy states that the Deputy Director of Enforcement Operations will be responsible for general oversight of all training for investigators. It further states that the Deputy should oversee the establishment of appropriate training programs and curriculum support. However, while several training courses have been offered during the past year, officials acknowledged that no systematic training policy has been established.

A conflict of interest policy was signed by the former Director on September 5, 1997. This policy prohibited employees from participating in matters in which they may have an actual or perceived conflict. However, employees were not required to document real or potential conflicts in writing. Further, we found no evidence that the policy was ever implemented or distributed to employees. A Department official stated that some employees do verbally report potential conflicts but he was unaware of any documentation of such reporting. (Finding 7, pages 27-31)

We recommended the Department establish written policies and procedures that ensure that all activities by enforcement division personnel are properly performed, documented, and reviewed; that systematic training is provided to investigators; and that real or potential conflicts of interest are disclosed in writing to management.

Department officials disagree with some of the specifics in this finding, however, they generally agree to make our recommended changes.

The Department of Professional Regulation has not developed procedures for including the person making the complaint in the disciplinary process, as required by statute. This finding is repeated from our Program Audit: "Physicians Regulated Under the Medical Practice Act."

Department officials stated that once the complaint is made and an investigation conducted, the Department becomes the complainant. Therefore, it does not need to include the person who originally made the complaint. They stated that any evidence he or she might have that might be helpful would be collected during the investigation, so his or her presence is not required. Further, they stated that for a formal hearing the prosecutor would subpoena the complainant’s testimony if it would aid the case. However, if not called to testify, the complainant is only notified of the final outcome.

Department rules (68 Ill. Adm. Code 1285.220) also allow the Department to resolve cases through an informal process, including a settlement conference. Officials stated they are not required to involve complainants in this informal conference because the statute refers specifically to a formal hearing. In cases settled by informal conference, the complainant is only notified of the final outcome.

The Medical Practice Act (225 ILCS 60/37) states that "both the accused person and the complainant shall be accorded ample opportunity to present in person, or by counsel, such statements, testimony, evidence or argument as may be pertinent to the charges or any defense thereto." Neither the formal hearing nor the informal conference, affords the complainant ample opportunity to present evidence as required by the Act. (Finding 9, pages 33-34)

Department officials disagreed with this finding. They stated the statutory provision cited deals with formal disciplinary proceedings. When the initial complainant is also a witness, they are always notified of the formal hearing date. They are subpoenaed to provide testimony. In the vast majority of these cases, the complaining individual would be a key witness at the hearing. In this fashion both the accused person and the complainant are afforded ample opportunity to present evidence.

However, the auditors point out that, as stated in the Department’s response, the complainant is given the opportunity to present evidence at a hearing only when the complainant is subpoenaed to testify as a witness. Therefore, in all other disciplinary cases, under both the informal and formal processes, the Department denies the complainant the opportunity that is granted by the statute to present evidence and testimony.

The Department experienced problems with the development and implementation of the Regulatory Administration and Enforcement System (RAES).

The Department did not completely define its needs and the requirements of RAES prior to execution of a contract with the vendor.

The Department published a Request for Information (RFI) on January 6, 1995. The vendor was selected after proposing a $675,000 "turn-key" solution, termed RAES. After selecting the vendor, the Department requested system modifications, and signed a contract with the vendor in April 1996, for an amount of $1,025,000.

The Department did not ensure that all contractual provisions were met and expended approximately an additional $700,000 on the development of RAES. For example additions included:

While the Department anticipated the necessity to modify the vendor selected "turn-key" solution, the additional costs incurred in completing this project were significant. (Finding 11, pages 38-40)

The Department concurred with our recommendation to review its system development, project management and contracting procedures prior to undertaking future large projects

The Department has not committed the necessary resources to ensure the Illinois Public Accounting Act (225 ILCS 450 et. seq.) is adequately regulated and enforced.

Currently, the Department only has one individual responsible for all investigations and prosecutions for the Public Accountant Profession. Many of the cases are complex and therefore the investigation and prosecution activities take an inordinate amount of time to complete. In complaints filed with the Department, the Investigator/Prosecutor could have as many as 50 cases at one time.

Inadequate resources of the enforcement process related to complaints filed against public accountants places the public at risk to accountants who are not fulfilling their professional responsibilities. (Finding 15, page 46)

Department officials concurred with our recommendation to reallocate or provide appropriate resources including contracts with outside sources.

The remaining findings are less significant and are being given attention by the Department. We will review progress toward implementing the recommendations during the Department’s next audit.

The auditors state the Department’s financial statements for the two years ending June 30, 1999 are fairly presented in all material respects.

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WILLIAM G. HOLLAND, Auditor General

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Pandolfi, Topolski, Weiss & Co., LTD. were our special assistant auditors for this audit.